Filler Means, Feeding Device and Method for the Forming of a Support Structure in a Bone Cavity

ABSTRACT

The invention relates to dry free-flowing filler ( 1 ) for forming a support structure in a bone cavity ( 4   a ). Said filler comprises a plurality of biocompatible support bodies ( 2 ) which are resistant to deformation or fracture under the physiologicalloads usually occurring in the bone cavity ( 4   a ). Said support bodies ( 2 ) have a size between 2 mm and 10 mm and an axis (A) and two opposite abutments ( 2   g ) spaced apart in the direction of the axis (A).

This application is a divisional of U.S. application Ser. No. 11/572,035 filed Jan. 12, 2007 which is a U.S. National Phase of PCT/EP05/007936 filed Jul. 14, 2005 which claims priority to European Application No. 04405451.8 filed Jul. 14, 2004. All of these are incorporated herein by reference in their entirty.

The present invention relates to a filler means for the formation of a support structure in a bone cavity. The invention furthermore relates to a feeding device for the filling of a filler means into a bone cavity. Furthermore the invention relates to a method for the filling of a bone cavity with a support structure.

The invention relates to the treatment of bones of humans or animals.

The increasing aging of society leads to an above average increase in diseases of the locomotion and support apparatus, in particular of the bones. Bones can be damaged or weakened in the most diverse manners, for example by trauma, infection, wear, tumor growth or degenerative illnesses such as osteoporosis. In older humans, osteoporosis, that is to say the depletion of the spongiosa, represents a problem because in this way the load carrying ability of the bone is weakened, which has the consequence that bone fractures increasingly occur, above all in the spinal column, at the neck of the femur and at the wrist. A treatment of such bone fractures is difficult, in particular when degenerative changes in an advanced state are present. For the fixation of such bone fractures external or internal splints (plates, screws, implants) are normally used which hold the bone together until it has healed. Such splints cannot, however, be used for all bones. Thus, for example, for the spine the so-called vertebroplastie is used for the treatment of a degenerated or partly fractured vertebral body and the damaged vertebral body is filled with bone cement. The use of bone cement in vertebral bodies however has various disadvantages, in particular that the bone cement can emerge in uncontrolled manner via veins or small bone defects in the vertebral body and can thereby cause damage in adjacent anatomic structures, such as for example on escaping into the spinal passage. Further disadvantages of bone cement are that it warms up strongly during hardening which can damage surrounding tissue or indeed nerves, that the bone cement must be very quickly processed, that no bone can grow in the bone cement and that the bone cement becomes brittle in the course of time.

The document US 2004/0052829 discloses a method for treatment of porous vertebral bodies, in particular of vertebral bodies with an osteoporotic fracture. For this purpose, a biocompatible liquid carrier substance such as water is used which is enriched with biocompatible support bodies. The disadvantage of this method is the fact that a balloon-like container is required which must first be introduced into the vertebral body and which is thereafter filled with the carrier substance containing the support bodies. The balloon-like container is required in order to ensure that both the liquid carrier substance and also the support bodies contained therein remain within the vertebral body. If no balloon-like container were used, then the known danger of outflow would also exist in this method in which the liquid carrier substance and also the support bodies contained therein, which have a size in the micrometer range, can escape out of the damaged vertebral body and can damage adjacent tissue in an uncontrolled manner or propagate in the human body. The known method thus has the disadvantage that it is complicated and expensive to introduce the balloon-like container into the vertebral body, that this can be damaged during the introduction or by the support bodies, so that the carrier substance can flow out and that the vertebral body can not be ideally filled because the balloon-like container “inflates” during the feeding of the liquid carrier substance and thus takes up more space than is necessary per se for the support bodies.

The document US 2004/0097930 discloses a further method for the treatment of vertebral bodies. This method discloses spherical bodies which are introduced into the internal space of the vertebral body. After the operation has been completed, the spinal column is loaded in the axial direction, that is to say in the direction of extent of the spinal column. This loading has the consequence that the ball-like bodies are urged radially to the axis of the spinal column, with the vertebral body bodies sinking in and being deformed. In an unfavorable case the ball-like bodies penetrate the jacket of the vertebral body and can thus be distributed in an uncontrolled manner in the human body. The document moreover discloses four-cornered bodies which are to be introduced into the inner space of the vertebral body. These four-cornered bodies mutually block one another during the supply such that these bodies cannot be introduced into the interior space of vertebral body. The disclosed method thus has the disadvantages that the bodies introduced into the vertebral body want to escape under load and/or that the bodies to be introduced cannot be supplied to the vertebral body.

It is thus the object of the present invention to propose a more advantageous, implantable and in particular injectable filler means which permits defective bones, in particular vertebral bodies, to be ideally supplied in such a way that the bones are able to carry the physiological loads that are present from the time of the implantation onwards.

This object is satisfied with a filler means capable of dry flow having the features of claim 1. The subordinate claims 2 to 24 relate to further advantageously designed filler means. The object is further satisfied with a feeding device for the introduction of the filler means having the features of claim 25. The subordinate claims 26 and 30 relate to further advantageous embodiments. The object is further satisfied with a method for the filling of a bone cavity with support bodies having the features of claim 31. The subordinate claims 32 to 40 relate to further advantageous method steps. The object is further satisfied with a system having the features of claim 41.

The object is in particular satisfied with a filler means capable of dry flow for the formation of a support structure in a bone cavity, with the filler means including a plurality of biocompatible support bodies, which are resistant to deformation or fracture under the physiological loads which normally occur in the bone cavity, with the support body having a size between 2 mm and 10 mm and an axis as well as two oppositely disposed abutment locations which are spaced apart in the direction of the axis. The abutment locations are preferably designed as abutment surfaces.

The expression “capable of dry flow” signifies that the filler means can be injected, but without using any sort of fluid carrier substance which could endow the support bodies with flow characteristics. The support bodies are selected to be sufficiently large in that they can all be displaced in a cannula, while lying behind one another within the cannula, in that a pressure is exerted on the rearmost support body and this force is transmitted to all of the support bodies located in the cannula so that the support bodies are moved in the cannula towards the tip of the cannula. The support bodies are aligned within the cannula in such a way that the abutment locations of two support bodies following one another each contact one another. These support bodies have dry flowing characteristics in that they have a type of flow characteristics within the cannula without a carrier substance, in that the support bodies, in similar manner to an injection, can be fed to a bone cavity via the cannula.

The expression “support body” designates a body which is able to carry the forces which occur in a vertebral body without being substantially deformed or indeed destroyed. A plurality of biocompatible materials are known from which such a support body can be manufactured. For example the support body can be manufactured from

-   -   ceramic materials, in particular calcium         phosphate/hydroxylapatite, aluminum oxide, zirconium oxide, ATZ         ceramic (aluminum zirconium oxide), bioactive glasses, glass         ceramic materials, porcelain or a combination thereof or     -   metallic materials in particular titanium, tantalum, stainless         steel, steel alloys such as cobalt chrome alloy, titanium alloys         such as titanium nickel alloy or titanium aluminum         niobium/vanadium alloy or a combination thereof, or     -   polymers, in particular polymethyl methacrylate (PMMA),         polyetherether ketone (PEEK), polyethylene (PE), polyethylene         terephthalate (PET) or a combination thereof, or biodegradable         polymers such as polylactate.

The filler means in accordance with the invention including a plurality of biocompatible support bodies has the advantages that no balloon or other bounding means is required in the bone cavity because, on the one hand, the filler means has no carrier substance such as a liquid which could run out because the filler means is capable of dry flow within the cannula and, on the other hand, because the filler means consists of individual relatively large support bodies which, as a result of their size, can also hardly escape in uncontrolled manner from a severely damaged vertebral body, and which, as a result of their size, cannot become distributed in an uncontrolled manner in the body. The filler means in accordance with the invention is capable of dry flow and can thus be injected into a bone cavity with the aid of a cannula. The filler means in accordance with the invention is thus also suitable in particular for the medical care of bones which are difficult to access such as vertebral bodies.

In a particularly advantageous embodiment the support bodies are designed such that they can mutually wedge one another so that the support bodies which are located in the bone cavity are mutually wedged and thereby form a cohesive support structure. The support bodies are preferably wedged such that they form a self-stable support structure. This is in particular important for loaded spinal columns.

The filler means of the invention permits bone defects, such as fractured bones, in particular weakened, fractured or partly fractured vertebral bodies to be filled with a support structure consisting of individual support bodies. Moreover, vertebral bodies which have been partly fractured can be aligned again. The support structure endows the bone with a stability, transmits forces which occur and can moreover promote bone healing and/or bone formation. The support bodies can, moreover, be filled with a bone healing and/or bone forming substance and/or be coated or have a bone healing and/or bone forming surface structure. The filler means in accordance with the inventions can be introduced into the bone by means of a supply device comprising a small cannula, which enables a caring access to the bone. In an advantageous embodiment the feeding device includes a force measuring device in order to measure the force which acts the support element on occur during introduction in the feed direction. In this way an excessive force is avoided during the introduction. Hereby a breaking through of the outer wall of the vertebral body is avoided. Moreover, the doctor has available an indicator via the introduction force which is able to say something about the state of filling of the vertebral body. In a further advantageous embodiment the feeding device includes a drive device which actuates a plunger provided in the cannula. The drive device exerts a mechanical force on the plunger and on the support bodies arranged in front of it in the feed direction, for example a constant force, a tap or a vibration. In a further embodiment the feeding device has a plunger which extends up to and into the bone cavity with the tip of the plunger serving as a manipulation instrument in order to change the position of the support bodies located within the bone cavity, for example to align them.

The invention will be explained in detail in the following with reference to Figures. There are shown:

FIG. 1 a plan view of a vertebral body with an inserted cannula;

FIG. 2 a section through a vertebral body into which the filler means has been introduced;

FIG. 3 a section through the vertebral body and also the cannula in accordance with FIG. 2;

FIG. 4 a section through the vertebral body with a fully introduced filler means;

FIGS. 5 a to 5 e schematic representations of differently shaped support structures;

FIGS. 6 a to 6 d support bodies with cornered outer contours;

FIGS. 7 a to 7 d support bodies with rounded outer contours;

FIGS. 8 a to 8 d support bodies with polyhedral outer contours;

FIG. 9 a further embodiment of a bone cavity partly filled with filler means;

FIG. 10 the fastening of a cannula in a bone;

FIG. 11 a cannula;

FIG. 12 a cannula tip;

FIG. 13 a pressing apparatus;

FIG. 14 a broken bone having a bone cavity;

FIG. 15 a cross-section through a cannula;

FIG. 16 a further cross-section through a cannula;

FIG. 17 a longitudinal section through a further vertebral body with a feed apparatus and support bodies which are to be introduced;

FIGS. 18 a-18 e differently designed plunger tips;

FIG. 19 a cross-section through a further vertebral body with introduced support bodies and also a plan view of a feeding device;

FIGS. 20 a-20 c longitudinal sections of differently shaped support bodies;

FIG. 21 a peripheral view of an abutment location;

FIGS. 22 a-b three individual support bodies arranged within one another;

FIG. 23 a further embodiment of a support body.

FIG. 1 shows in a plan view a bone 4, specifically a vertebral body having an internal bone space 4 a. The term internal bone space 4 a will be understood to mean the entire volume taken up by the bone 4. In the internal bone space 4 a there is a bone cavity 4 b into which a cannula 6 opens. The bone cavity 4 b can for example have arisen because of degenerative processes, in particular osteoporosis. The bone cavity 4 b can also be artificially produced or enlarged with a suitable instrument.

FIG. 2 shows a vertebral body 4 having an internal bone space 4 a and also a supply device 5 comprising a cannula 6, a pressing device 9 with an actuating handle 9 b and a plunger 9 c. The cannula 6 opens into the internal bone space 4 a which in this embodiment has no bone cavity 4 b. Biocompatible support bodies 2 are arranged behind one another in the inner space of the cannula 6 and of the pressing device 9 and are arranged substantially mutually touching one another so that the plunger 9 c acting on the rearmost support body 2 drives all support bodies 2 in the direction of the internal bone space 4 a. This makes it possible, if necessary, to transfer the force applied to the actuating handle 9 b via the support bodies 2 up to the support bodies 2 located at the tip of the cannula 6, so that these penetrate into the internal bone space 4 a with a corresponding force and thereby form a bone cavity 4 b during the penetration. The inner diameter of the cannula 6 and also of the pressing device 9 are designed and matched with respect to the outer diameter of the support bodies 2 in such a way that the support bodies 2 are arranged behind one another in the flow direction, i.e. towards the outlet opening of the cannula 6, which has the consequence that the totality of the support bodies 2 form a filler means 1 capable of dry flow which has flow characteristics without any form of lubricant, in that support bodies 2 can be supplied with a syringe-like device shown in FIG. 2 to the internal bone space 4 a. The cannula 6 can also extend in curved manner or consist of a flexible or solid material.

The vertebral body 4 shown in FIG. 3 in section has a bone cavity 4 b which was produced prior to the insertion of the support bodies 2 with a special instrument. Thereafter the tip 6 a of the cannula 6 is driven forward up to the bone cavity 4 b and thereafter the support bodies shown in a side view are introduced individually following one another and in a defined mutual position so they become distributed in random manner in the bone cavity 4 b. The cannula 6 has a round internal cross-section so that each support body 2, which are all identically designed, has an elongate spherically extending outer contour. The support body 2 has a maximum dimension between 2 mm and 10 mm. The support bodies 2 are designed as solid bodies. All support bodies 2 are identically designed with respect to dimension and shape.

FIG. 4 shows the vertebral body shown in FIG. 3 with a bone cavity 4 b completely filled with support bodies 2, with the support bodies 2 contacting one another at different points and thereby being entrapped in the bone cavity 4 b so that the totality of these support bodies 4 form a load bearing support structure. The access passage to the bone cavity 4 b is closed with a plug 4 c after the introduction of the support bodies 2.

An internal bone space 4 a or a bone cavity 4 b can be filled with the most diversely shaped support bodies 2. FIG. 5 a shows schematically a bounded bone cavity 4 b with an inlet opening 4 c through which the ball-like support bodies are introduced. FIG. 5 b shows an ellipsoidally designed support body 2. An advantage of the support bodies shown in FIGS. 5 a and 5 b with a spherical outer contour is the fact that they can be mutually displaced with a low expenditure force so that the support bodies 2 can very readily fill the volume of the bone cavity 4 b. The FIGS. 5 c and 5 d show support bodies 2 with an edge-like outer contour, with the side surfaces of the support bodies 2, which converge at an angle, being able to exert a wedge action so that the support bodies 2 located in the bounded bone cavity 4 b can become mutually wedged in an advantageous embodiment such as is shown in FIG. 5 c, with larger intermediate spaces resulting between the support bodies 2 into which the bone can grow. The totality of the support bodies 2 in turn forms a mechanically loadable support structure. In contrast to the support bodies 2 shown in FIGS. 5 a to 5 d, which are respectively identical having regard to their shape and size, the support bodies 2 could also have different shapes and/or sizes within the bone cavity 4 b as shown in FIG. 5 e.

The FIGS. 6 a-6 d and 7 a-7 d show support bodies 2 which have an axis A, with each support body 2 having two oppositely disposed abutment locations 2 g which are spaced apart in the direction of the axis A. The abutment locations 2 g of FIGS. 6 a-6 d and also of FIG. 7 d are designed as abutment surfaces 2 g, whereas the abutment locations 2 g of FIGS. 7 a-7 c are designed as rings with a small mutual contact surface. In the embodiments of FIGS. 6 a-6 e the abutment locations 2 g extend perpendicular to the axis A. In the embodiments in accordance with FIGS. 7 a-7 d the abutment locations 2 g have a circular or spherical or curved extent. The abutment locations 2 g of the embodiments of FIGS. 7 a-7 c can also be of ring-like shape extending perpendicular to the axis A. The support bodies 2 have, as shown in FIGS. 6 a-6 c, 7 a-7 c, a recess disposed perpendicular to the abutment point 2 g. This cut-out 2 c can be designed as a recess or also as a through-going, open, internal cavity 3 which extends between two oppositely disposed abutment locations 2 g and opens into the oppositely disposed recesses 2 c. The cut-out 2 c can be eccentric or, as shown in FIGS. 6 a-6 c, 7 a-7 c, extend concentrically to the axis A. The support bodies 2 can also consist of two or also more partial bodies, for example of four partial bodies which can move independently of one another in the bone cavity.

The FIGS. 6 a-6 b and 6 c and also 7 a, 7 b and 7 c show support bodies 2 having an open inner cavity 3. An open inner cavity 3 will be understood to be a hollow cavity in the support body 2 which is open towards the outside, in contrast to a closed cavity which is arranged completely within the interior of the support body 2 without having an opening towards the outside. These support bodies 2 also have a maximum size in the range between 2 mm and 10 mm. Each support body 2 includes a total volume which corresponds to the volume of the material of the support body 2 and also its inner cavity 3. The volume of the inner cavity is larger than 30% of the total volume, preferably larger than 50% and can amount to up to 90%. The size of the maximum possible volume of the internal cavity 3 is dependent on the maximum pressure forces acting on the support body 2. These pressure forces are dependent on the specific internal bone space 4 a and/or the bone 4 in which the support structure is formed. The load carrying ability of the support body 2 is naturally dependent on the material used. If the support body 2 is for example made of metal the internal cavity 3 can be made relatively large and the support bodies 2 are nevertheless resistant to the pressure forces that are acting. If the support body 2 is made of a material such as bioglass or a resorbable substance, the internal cavity 3 must be made smaller percentage-wise in accordance with the material characteristics in order to provide the support body 2 with a sufficiently large load carrying force. This internal cavity 3, in particular a relatively large internal cavity 3 percentage-wise, has the advantage that it can be filled in the course of time by growing bone material. In a particularly advantageous design the internal cavity 3 of the support body 2 is at least partly filled prior to its introduction with an osteo-inductive and/or osteo-conductive substance, in particular a bone growth promoting protein or calcium sulphate or a combination of these or further substances. Thanks to such filled support bodies 2 it is possible to feed both a support structure and also osteo-inductive and/or osteo-conductive substances to the internal bone space 4 a by means of the filler means 1 capable of dry flow and consisting of a plurality of support bodies 2. This design has the advantages that the filler means 1 can be supplied to the internal bone space 4 a dry so that no danger exists of anything running out through cracks, gaps and openings which may possibly be present in the bone. Moreover, the osteo-inductive substance brings about bone growth so that the hollow spaces 3 and the intermediate spaces which result through the support bodies 2 are advantageously increasingly filled with growing bone. Since the support bodies 2 in the internal bone space 4 a are arranged aligned at random, that is to say the hollow spaces 3 extend in random directions and also the intermediate spaces extend in random directions and have a size determined by chance, the support bodies 2 actually form a support structure similar in the broader sense to spongiosa, in particular when the volume of the internal cavity 3 amounts to more than 50% of the total volume. When, in the course of increasing healing, the hollow cavities 3 and the intermediate spaces are filled with growing spongiosa, then a support structure forms in the internal bone space 4 a which is partly comparable with a healthy bone, with randomly aligned support bodies 2 the hollow cavities and intermediate spaces of which have spongiosa growing through them.

The inner cavity 3 of the support bodies 2 in accordance with FIGS. 6 a, 6 b, 6 c, 7 a, 7 b, 7 c is made cohesive and non-porous so that the internal contour 2 b bounds a relatively large internal cavity 3 laterally. The internal cavity 3 in accordance with the FIGS. 6 a, 6 b, 7 a, 7 b is of cylindrical shape, extends concentric to the axis A and has a circular opening 2 c. The angle between the internal wall of the internal cavity 3 and the abutment location 2 g thus amounts to 90 degrees at the circular opening 2 c. The circular opening 2 c can, as shown in FIG. 6 b, have blocking points 2 h, for example a plurality of notches arranged in the peripheral direction. The opening 2 c can have the most diverse shapes and can for example also be formed as a triangle, tetragon or as a frequency polygon. The internal cavity 3 could have the same shape as given by the opening 2 c, with the internal cavity 3 extending in the axial direction A over the entire length of the support body 3. The support bodies 2 in accordance with FIGS. 7 a, 7 b are made essentially circular. The support bodies 2 in accordance with the FIGS. 6 a, 6 b have a polyhedral outer contour in the peripheral direction with edges 2 d extending parallel to the axis A and six surfaces 2 f which extend in a mutually wedge-shaped manner which respectively meet at an edge 2 d or corner 2 e. The support body 2 has a preferably 3-cornered to 10-cornered outer contour in the peripheral direction, in particular a 4-cornered, 5-cornered or 6-cornered outer contour. The edges 2 d can have blocking points 2 h, as shown in FIG. 6 b, such as notches.

The embodiment in accordance with FIG. 7 a has a spherical, in particular ball-shaped or episoidal outer contour. The support bodies 2 in accordance with the FIGS. 6 b and 7 b are essentially of hollow cylindrical shape. The support bodies 2 in accordance with FIGS. 6 c and 7 c have essentially a cuboid or spherically extending outer contour. The support bodies 2 in accordance with FIGS. 6 d and 7 d have, in distinction to the embodiment of FIGS. 6 a, 7 a, no hollow cavity 3.

The FIGS. 8 a to 8 d show further embodiments of support bodies 2 with polyhedrally extending outer contours, with the illustrated support bodies 2 not having any hollow space 3. The support bodies 2 could however also have a cavity 3. FIG. 8 a shows a tetrahedron, FIG. 8 b an octahedron, FIG. 8 c an ikosahedron and FIG. 8 d a small star-shaped dodecahedron. The two oppositely disposed abutment locations 2 g spaced apart in the direction of the axis A, which are necessary in order to forward this embodiment in a cannula in the direction of the axis A, are not shown in this embodiment.

In an advantageous design, as shown in FIG. 6 a, the support body 2 has an outer diameter D and a height H extending orthogonal to it, i.e. in the direction of the axis A, with the outer diameter D preferably amounting to 1.5-times the height H. The support bodies 2 have a surface formed such that the surface of a filling body 2 filled into the bone cavity can project into the cut-out of an adjacently disposed support body 2 as shown in FIG. 9. In an advantageous embodiment the support bodies 2 have surfaces and also recesses designed such that mutual wedging or jamming occurs between the surfaces which project into the cut-outs and the cut-out, in order to form within the internal bone space 4 a a preferably cohesive and in particular self-stable support structure. The surface of the support body 2 which is radial to the axis A thus preferably has shapes from the group: corner, edge, tip, recess, aperture or a combination thereof in order to bring about a mutual wedging and jamming of the support bodies 2. In an advantageous embodiment the support body 2 has, as shown in FIG. 6 a, a form similar to a threaded nut with a multi-cornered outer contour extending in the direction of extent of the axis A with surfaces 2 f which mutually extend in wedge-like manner and pronounced edges 2 d and corners 2 e as well as an inner cavity 3 with an opening 2 c of relatively large diameter. FIG. 9 shows a first bone cavity 4 b partly filled with such threaded nut-like support bodies 2. It is evident from this arrangement of the support bodies 2 how the support bodies 2 are mutually wedged in that the outer contour partly penetrates via the opening 2 c into the internal space 3, so that the support bodies 2 are mutually wedged and in this way form a mechanically at least cohesive support structure. As soon as the entire bone cavity 4 b is completely filled with the support bodies 2 the support structure formed in this way can carry the load acting on the bone 4 from the outside essentially as a composite assembly. The filler means 1 introduced into the internal space 4 a of a vertebral body, comprising a plurality of, for example, 20 to 50 support bodies 2, preferably forms a self-stable support structure in that the individual support bodies 2 are mutually wedged in such a way that the support structure which is formed is held together by a force acting in the direction of extent of the spinal column. If the internal space 4 a were filled with spherical support bodies, then these would attempt, with a force acting in the direction of extent of the spinal column, to escape in a direction perpendicular to the force, which produces an excessive force on the outer jacket of the vertebral body or can indeed lead to damage to the outer jacket and to the escape of the support bodies. Through the mutual wedging of the support bodies this excessive force acting on the outer jacket is considerably reduced. The arrangement of the support bodies 2 shown in FIG. 9, or a very similar arrangement, also results when these are pressed into the vertebral body as shown in FIG. 17.

FIG. 14 shows a broken bone 4, with a bone part missing at the position of the fracture. This part is covered over with a bone plate 10 so that a bone cavity 4 b forms. A bone cavity 4 b of this kind can also be filled with the above-described filler means 1 comprising support bodies 2.

FIG. 10 shows rigid cannula 6 with a cannula tip 6 a formed as a cutting thread 6 c. A Kirschner wire 8 extends within the cannula 6. The Kirschner wire 8 is first pushed into the bone 4 an order to determine the direction of extent of the cannula 6. Thereafter the tip 6 a of the cannula 6 is screwed with a rotating movement into the bone 4 using the handle 7 so that the tip 6 a and thus the cannula 6 is firmly anchored in the bone 4. Thereafter the handle 7 is removed. FIG. 11 shows the cannula 6 with the removed handle 7. The cannula 6 includes a connection part 6 b for the handle 7 and for a pressing device 9 respectively. FIG. 12 shows an embodiment of a tip 6 a of the cannula 6 in detail. The tip 6 a has projecting cutting elements 6 e and an outer thread 6 d. FIG. 13 shows a pressing device 9 which is connected via the connection part 6 b to the cannula 6. Prior to the connection the cannula 6 was filled with support bodies 2. The pressing device 9 includes a handle 9 a and also an actuating grip 9 b which acts on a plunger 9 c in such a way that it moves a bit further into the cannula 6 at each actuation, so that the plunger 9 c acting on the support bodies 2 presses the support bodies 2 which are arranged at the foremost position in the cannula 6 into the bone 4. The support bodies 2 thus flow into the bone 4 and in this way also form a bone cavity 4 b therein as a result of the pressure and fill it with support bodies 2 so that a support structure is formed within the bone 4. The position of the plunger 9 c can be read off with the aid of markings 6 f applied to the cannula 6 from which it can be determined how many support bodies have been pressed into the bone 4. The support bodies 2 could also be arranged in an additional cannula which is introduced into the cannula 6 before the pressing device is connected to the cannula 6. Thus a second cannula which contains the support bodies 2 would be arranged within the cannula 6. In this way the cannula 6 could be loaded very simply with support bodies 2. The cannula containing the support bodies 2 must have an internal diameter matched to the size of the support bodies in such a way that the support bodies 2 can only be arranged following one another and are displaceable therein in order to supply the support bodies 2 one after the other to the internal bone space 4 a. After the filling of the internal bone space 4 a the pressing device 9 and the cannula 6 are removed and the hole in the bone is closed with a plug 4 c as shown in FIG. 4.

The cannula can not only have a round internal cross-section as shown in FIGS. 10 to 13 but also other cross-sectional shapes, for example a hexagonal internal cross-section as shown in FIG. 15, or a rectangular internal cross-section as shown in FIG. 16, which are for example suitable for the introduction of the support body 2 shown in FIG. 6 a. The cannula 6 can also have further cross-sectional shapes matched to the respective contour of the support body 2 that is used.

The tip 6 a of the cannula 6 can also be designed without a fastening means 6 c. In particular, if a bone cavity 4 b has already previously been formed, the support bodies 2 could also be fed, as shown in FIG. 2, to the bone cavity 4 b with a device 9 similar to a syringe. In an advantageous method a group of support bodies, for example 5 or 10 support bodies following one another, is in each case supplied to the bone cavity 4 b, thereafter the cannula 6 is removed and the support bodies 2, which are located in the bone cavity 4 b, are additionally pressed in and compressed with the aid of a stuffing tool in order to thereafter replace the cannula at the bone 4 and to introduce a further group of support bodies 2 into the bone cavity 4 b and to compress these again with the stuffing tool.

In a possible method step an osteo-inductive and/or osteo-conductive substance can be supplied after the support bodies 2 have been introduced into the internal bone space 4 a, for example as a liquid or as a fluid, in order to fill the still present hollow cavities in the bone cavity 4 b with this substance. The filler means 1 could also be supplied to the internal bone space 4 a together with a fluid in that, for example, the support bodies 2 are made available together with the fluid, in particular mixed, in the pressing device 9 for introduction into the internal bone space 4 a.

FIG. 17 shows a longitudinal section through a vertebral body 4 with a cannula 6 introduced into its internal bone space 4 a. The support bodies 2 are designed as shown in FIG. 6 a and have abutment locations 2 g spaced apart in the direction of the axis A which lie against and mutually contact one another in the direction of the axis A. The support bodies 2 are pushed or pressed into the internal bone space 4 a by means of a plunger 9 c moved in the direction B on which a force F acts, with the support bodies 2 becoming randomly arranged in the internal bone space 4 a and moreover forming a bone cavity 4 b in the illustrated embodiment. The support bodies 2 located in the cannula 6 are arranged following one another and are otherwise identically arranged with respect to their position, if a cannula 6 in accordance with FIG. 15 is used. If the cannula 6 with a circular cross-section is used, then the support bodies 2 are also arranged following one another, but, with respect to their mutual position, could also be arranged rotated around the axis A. Since the support bodies 2 are arranged in defined manner inside the cannula 6 in the direction of extent of the axis A, i.e. in the direction of movement B, the support bodies 2 can be reliably displaced to the internal bone space 4 a and with small resistance. The support bodies 2 can be structured radially to the axis A in the most diverse manner and for example have edges 2 d, notches 2 h or also projecting tips or cut-outs without these structures hindering the introduction of the support bodies through the cannula 6. The forces are reliably transmitted between the abutment locations 2 g of the support bodies 2 and no mutual wedging of the support bodies takes place within the cannula 6 so that the support bodies can be reliably displaced into the internal bone space 4 a. Within the internal bone space 4 a the support bodies 2 order themselves arbitrarily, so that they mutually hinder one another with respect to their movement and mutually wedge and block one another.

FIG. 19 shows, in a cross-section of a vertebral body 4 a plurality of approximately 20 introduced support bodies 2 which are randomly distributed in a cloud-like manner within the internal bone space 4 a. In order that the internal bone space 4 a is uniformly filled, the pressing device 9 is mounted after the first insertion of the support bodies 2, preferably the a point designated by 4 c, in order to likewise supply support bodies 2 at this point.

The plunger 9 c can have markings 9 e in order to monitor the depth of penetration of the plunger 9 c. The length of the plunger 9 c can be selected such that its front part can be introduced up to and into the internal bone space 4 a, for example by up to a centimeter. The tip of the plunger 9 c can, as shown in FIGS. 18 a and 18 b, be made flat or rounded. Such plungers are also termed compressing plungers. The supply device 5 preferably has a plurality of differently designed plungers 9 c. For example the plunger 9 c could have an obliquely extending tip as shown in FIG. 18 b. This can serve to align or to shift support bodies 2 already arranged within the vertebral body 4. A plunger 9 c of this kind can also be termed a positioning plunger. The position of the support bodies 2 in the vertebral body 4 can be made visible with the aid of an X-ray image so that a doctor can change or correct the support bodies 2 with correspondingly designed tools such as plungers, hooks or tongs. FIG. 18 d shows a plunger 9 c with a controllably arranged tip. FIG. 18 e shows a plunger 9 c with a projecting guide part which can for example engage into the hollow space 3 of a support body 2.

The pressing device 9 shown in FIG. 19 includes a force measuring device 9 f with which the force produced in the direction of movement B is measured and is preferably also directly indicated. The force measuring device 9 f can, for example, include a spring and also a display so that the doctor can directly measure the force exerted onto the support bodies 2. The force measuring device 9 f can, for example, also be designed as an electronic apparatus including, for example, a piezo-crystal and also a display or an acoustic output, with the measured signal also being supplied to a monitoring device 11. The maximum force exerted on the support bodies 2 is preferably restricted. The force measurement provides an indication of the state of filling, for example the wedging of the support bodies. The pressing device 9 preferably includes a handle 9 h.

The pressing device 9 could also include a drive 9 g in order to bring about a force, blows or vibrations on the support bodies 2. In an advantageous method step a plurality of support bodies 2 is supplied to the internal bone space 4 a and thereafter a vibrating force is exerted on the support bodies 2 in order to compress the support bodies 2 located in the internal bone space 4 a and in order to thus obtain a high packing density and in order to thereby feed a large number of support bodies 2 to the internal bone space 4 a. The frequency of vibration preferably lies in the range between 1 and 15000 Hz, in particular between 5 and 50 Hz.

In an advantageous embodiment the drive device 9 g produces an elastic shock wave which is transferred into the plunger 9 a which has the consequence that the length of the plunger 9 a is varied, for example by +/−2 mm at a frequency of preferably between 1 and 50 Hz.

The drive device 9 g could also be connected to a monitoring device 11 and the maximum force and/or the frequency and/or the stroke could be monitored.

The FIGS. 20 a to 20 c show differently designed support bodies 2 with rounded or, for example, hexagonal outer contour in a longitudinal section along the axis A. In FIG. 20 a the abutment locations 2 g are designed as abutment surfaces, with the abutment locations 2 g arranged at the left having a reduced support surface in comparison to the abutment locations 2 g arranged at the right. The support bodies 2 illustrated in FIG. 20 b have at the left-hand side a circular abutment 2 g which extends fully in the peripheral direction. A plurality of individual projecting elements, for example hemispherically projecting elements, could also be arranged distributed in the peripheral direction, with each element forming an abutment location 2 g. The support bodies 2 shown in FIG. 20 c have abutment locations 2 g which are designed as truncated cone-like surfaces. An advantage of this design is that the support bodies are mutually centered on displacement in the direction of the axis A. The support bodies 2 could also have different outer diameters as shown in FIG. 20 c.

FIG. 21 shows in an outside view a development of the abutment locations 2 g between the two support bodies 2. These areally designed abutment locations 2 g mutually engage within one another which prevent a mutual rotation of adjacent support bodies 2 as they are pushed in. The abutment locations 2 g could also be of form-fitted design.

FIG. 22 a shows in a side view three support bodies 2, two U-shaped support bodies 2, which surround a cylindrical support body 2. These three support bodies 2 are arranged in the cannula 6 in such a way that they can be supplied to the internal bone space 4 a via the abutment locations in the direction of the axis A as shown in a side view in FIG. 22 b, with the three support bodies 2 becoming randomly arranged within the internal bone space 4 a since these are not mutually connected together.

The surface of the support body 2 located within the two U-shaped support bodies 2 can be of any desired shape and can for example also have edges or points, also at its end surfaces. The support bodies 2 shown in FIGS. 20 a-20 c and also 22 a and 22 b can, for example, be of circular or multi-cornered design radial to the axis A; or can also have tips, edges, cut-outs or apertures.

The end face of the plunger 9 c can be designed in a plurality of shapes and can for example also have the end faces shown in FIGS. 20 a to 20 c.

FIG. 23 shows a further support body 2 with abutment surfaces 2 g. The arms could be designed in a plurality of different forms with it having to be ensured that one abutment surface 2 g or an abutment location 2 g is present on the front side and also on the reverse side in each case.

The support bodies 2 shown in FIGS. 8 a to 8 d could have abutment locations 2 g spaced apart in the direction of an axis A. For example, the support body 2 shown in FIG. 8 b can have a self-centering abutment location 2 g at the uppermost and lowermost tip as shown in FIG. 20 c, so that a plurality of said support bodies 2, which are arranged behind one another in a cannula 6, which mutually contact each other at the abutment locations 2 g, are displaceable in the direction of the axis A and can thus be fed to the internal bone space 4 a. 

1. A dry flowable filler material (1) for the formation of a support structure in an internal bone space (4 a), comprising: a plurality of biocompatible support bodies (2) which are resistant to deformation or fracture under physiological loads within the internal bone space (4 a), with the support bodies (2) having a size between 2 mm and 10 mm and wherein the support bodies (2) have an axis (A) and also two abutment locations (2 g) each facing in opposite directions and spaced apart from each other along the direction of the axis (A), wherein the abutment locations (2 g) extend perpendicular to the axis (A), and wherein in between the abutment locations (2 g) the support bodies (2) have, in circumferential direction of the axis (A), a polyhedral outer contour with planar surfaces (2 f), and wherein the planar surfaces (20 are delimited by edges (2 d) extending parallel to the axis (A).
 2. The filler material in accordance with claim 1, wherein the support bodies (2) have a 3-cornered to 10-cornered outer contour.
 3. The filler material in accordance with claim 2, wherein the support bodies (2) have a 4-cornered, 5-corndered or 6-cornered outer contour.
 4. The filler material in accordance with claim 1, wherein the abutment location (2 g) has a recess (2 c).
 5. The filler material in accordance with claim 4, wherein the support bodies (2) have an outer contour shaped such that the outer contour of a support body (2) filled into the internal bone space (4 a) can project into the recess (2 c) of an adjacently disposed support body (2).
 6. The filler material in accordance with claim 5, wherein the outer contour and the recess (2 c) of the support bodies (2) are shaped in a mutually fitting manner such that mutual wedging occurs between the outer contour projecting into the recesses (2 c) and the recess (2 c).
 7. The filler material in accordance with claim 6, wherein the wedging is able to produce a cohesive self-stable support structure within the internal bone space (4 a).
 8. The filler material in accordance with claim 4, wherein the recess (2 c) extends concentrically to the axis (A).
 9. The filler material in accordance with claim 4, wherein the support bodies (2) have an open inner hollow cavity (3) which opens into oppositely disposed recesses (2 c).
 10. The filler material in accordance with claim 9, wherein the inner hollow cavity (3) is of cylindrical shape and extends in the direction of the axis (A).
 11. The filler material in accordance with claim 9, wherein each support body (2) takes up a total volume which includes the volume of a material of the support body (2) and also its inner hollow cavity (3), with the volume of the inner hollow cavity (3) amounting to more than 30% of the total volume.
 12. The filler material in accordance with claim 11, wherein the volume of the inner hollow cavity (3) amounts to more than 50% of the total volume.
 13. The filler material in accordance with claim 1, wherein all support bodies (2) are identically configured with respect to size and shape.
 14. The filler material in accordance with claim 4, wherein the recess (2 c) has blocking points (2 h).
 15. The filler material in accordance with claim 1, wherein the edges (2 d) have blocking points (2 h).
 16. The filler material in accordance with claim 1, wherein the support bodies (2) have an outer diameter (D) and orthogonal to it a height (H) in the direction of the axis (A) and wherein the outer diameter (D) amounts to at least 1.5 times the height (H).
 17. The filler material in accordance with claim 1, wherein the support body (2) is configured in shape of a nut having two abutment locations (2 g) extending perpendicular to the axis (A) and with a multi-cornered outer counter with edges extending parallel to the axis (A).
 18. The filler material in accordance with claim 17, wherein the support body (2) has a cylindrical inner cavity (3) extending in the direction of the axis (A) which opens at both ends into the abutment location (2 g).
 19. The filler material in accordance with claim 1, wherein the support bodies (2) comprise a ceramic material, calcium phosphate/hydroxylapatite, aluminum oxide, zirconium oxide, ATZ ceramic (aluminum zirconium oxide), a bioactive glass, a glass ceramic material, porcelain, or a combination thereof, or a metallic material, titanium, tantalum, stainless steel, a steel alloy, a titanium alloy, or a combination thereof, or a polymer, polymethyl methacrylate (PMMA), polyetheretherketone (PEEK), polyethylene (PE), polyethylene terephthalate (PET), or a combination thereof, or a biodegradable polymer.
 20. The filler material in accordance with claim 4, wherein the recess (2 c) or the interior cavity (3) is filled with at least one osteo-inductive and/or osteo-conductive substance.
 21. The filler material in accordance with claim 1, wherein the support bodies (2) comprise a plurality of partial bodies.
 22. A feeding device (5) for the supplying of a filler material (1) according to claim 1, wherein the filler material (1) is capable of dry flowing into an internal bone space (4 a), wherein the supply device (5) includes a cannula (6) with a cross-section matched to that of the size of the support bodies (2) in such a way that the support bodies (2) can be supplied following one another within the cannula (6) aligned in the direction of the axis (A) to the internal bone space (4 a) and with the feeding device (5) including a pressing device (9) having a plunger (9 c) displaceable in the cannula (6) with which a force can be exerted in the feeding direction on the support bodies (2) located within the cannula (6) in order to supply the support bodies (2) to the internal bone space (4 a) under pressure, wherein the pressing device (9) includes a drive device (9 g) which drives the plunger (9 c) in the feeding direction, and wherein the driving apparatus (9 g) exerts a vibrating force on the plunger (9 c).
 23. The feeding device in accordance with claim 22, wherein the pressing apparatus (9) includes a force measuring device (9 d) for the measuring of the thrust force acting on the support bodies (2) in the feeding direction.
 24. The feeding device in accordance with claim 22, wherein the plunger (9 c) has a length such that its front part section can be introduced up to and into the internal bone space (4 a).
 25. The feeding device in accordance with claim 24 including a plunger (9 c) having a tip formed on it or movable on it such that it can act on a filler material (1) located within the internal cavity (4 a) of the bone and change its position, in particular transverse to the feeding direction.
 26. The feeding device in accordance with claim 22, wherein the driving apparatus (9 g) produces an elastic shock wave which is transferred into the plunger (9 c).
 27. A kit for the fixing and further enlargement of a partly fractured vertebral body including a plurality of filler materials in accordance with claim 1, and a feeding device (5) including a cannula (6) having an internal cross-section matched to the size of the support bodies (2) such that the support bodies (2) can be fed within the cannula (6) following one another in the same aligned position and contacting one another mutually at the abutment locations (2 g) to the internal bone space (4 a) in the direction of the axis (A) and also comprising a plunger (9 c) displaceable in the cannula (6) with which a force can be exerted in the feeding direction (A) onto the rearmost of the support bodies (2) located in the cannula (6). 